Sunday, September 30, 2007

Bouts of fierce anger, depression, and anxiety that previous generations of soldiers described as "shell shock" or "combat/battle fatigue" now earn a clinical diagnosis: Post-Traumatic Stress Disorder. But the relatively new medical label doesn't guarantee soldiers will get the care they need. NOW looks at how America's newest crop of returning soldiers is coping with the emotional scars of war, and some new and innovative treatments for them.

In the show, we spent time with Iraq War veteran Michael Zacchea, a Marine lieutenant colonel who trained Iraqi troops and fought in the battle of Fallujah. Haunted by the violence he saw there, Zacchea and other soldiers diagnosed with PTSD now face what could be a lifelong struggle to leave the horrors of war behind and reclaim their once-peaceful lives.

Saturday, September 29, 2007

A book signing at Tempe's Changing Hands Bookstore this summer gave me the pleasure of meeting Betty Merritt, founder of the Merritt Center and Lodge in Payson, Arizona. She told us about her center's healing retreats for veterans:

Through group and individual activities, participating veterans will learn to recognize the triggers of negative combat experience and learn ways to release negativity and reorder their personal priorities. They will learn to cleanse themselves of toxins of mind, body, emotions and spirit. The final retreat weekend will include family members who will join in a celebration of service and the awakening of a new vision of their future.

Betty's energy is boundless. She conducts the programs and often cooks healthy home-style meals herself. In her empowerment programs, she teaches what she calls the Cycle of Life. During the sessions, the participants ask themselves three questions. Who am I? Why am I here? What do I value? She teaches, "We do not have to be a victim. We can dream to create a new structure."

This retreat attempts to help the veteran create a new structure by addressing four areas, the physical, mental, emotional and spiritual in a four-weekend program. There is time to talk, walk around the grounds and in the forest, relax in the hammocks, eat healthy snacks anytime and learn exercises and techniques to help them at home. When they leave they have phone numbers of the veteran mentors and others from the program that they can call 24 hours a day.

Details on program components:

The 13-acre Merritt Center offers a home-like, simple retreat in a rural area of Star Valley near Payson that allows the participants the freedom of forest exploration, a family-like setting for meals and small, but welcoming, accommodations.

For the physical sessions, they take walks in the forest and learn Trauma Release Exercises (TRE). David Berceli developed the TRE tools and has years of experience in trauma intervention. He has conducted post-deployment training in combat operational stress for the military. ...[he] believes the body stores memory. These exercises elicit mild tremors that release deep chronic tension in the body to assist the individual in the trauma healing process. ...

In talking about the Returning Veterans Program, Betty said, "This is a unique resource because we provide a safe space and provide a place for trust to develop quickly." All the people who work in this program are volunteers -- from the people who conduct the daily programs, to those who facilitate the groups and cook the meals.

Betty learned from the vets that, "Combat is nasty stuff," and with the help of veterans, she started the program because, for her, and others, "War hurts my heart." ...The Returning Veterans Program, costs the Merritt Center about $150 for each participant, each weekend. With the help of the many volunteers and private donations, the retreat remains free to any returning combat veteran of any war.

A way to support their much-needed work:

On Saturday, Oct. 20 there will be an Octoberfest fund-raiser at the Merritt Center to make this retreat available to many more veterans. For information call 928-474-4268. ...

On Tuesday, the government moved to dismiss "in its entirety" a class action lawsuit filed against the VA by veterans groups. Details from a Veterans for Common Sense/Veterans United for Truth press release:

Plaintiff veterans groups vowed to continue their fight for timely medical treatment and compensation for wounded veterans...The veterans class action lawsuit...seeks to force the VA to follow the law and provide timely medical care and disability benefits for veterans suffering from post-traumatic stress disorder (“PTSD”).

Ignoring the long litany of charges about the defects in the VA system and statutes and abuses of veterans, the government argues that all claims by anyone about the treatment of our veterans must be “channeled” through that same system, however flawed. Defendants belittle the Complaint as merely raising “frustrations with political processes,” and urge that the problems described therein can only be addressed to “representative branches of government.”

Paul Sullivan, Director of VCS, commented that “The VA ought to be ashamed. Veterans deserve their day in Court. Every day the VA fights our lawsuit means another day that our wounded veterans go without medical care and disability payments.”

Click on 'Article Link' below tags for more...

Continuing:

Bob Handy, Chairman of VUFT, stated that “What the VA is essentially saying is that the VA could decide to put all veterans claims on ice for ten years and then just flip a coin, and that there would be nothing a veteran could do about it. This continues its shameful attacks on veterans, reinforcing the view held by many that the government considers veterans to be second class citizens. Every veteran and every citizen in our country should be appalled by this betrayal. We will never give up our fight for justice for the defenders of our liberty.”

The VA also argues to the Court that the veterans groups bringing the case (VCS and VUFT), which it labels as mere “advocacy” groups, lack “standing” to raise claims on behalf of their members (i.e. veterans), and that veterans do not have the right to sue as a group, but rather, each veteran must file separately.

As to the government’s failure to provide health care to returning veterans, the government argues that its obligations to veterans are not mandatory, i.e., it can provide as little or as much health care as it desires. VCS and VUFT are sure that this is not what the military recruiters tell prospective soldiers.

“Just last week, the [VA's Inspector General] caught the VA lying to Congress about how much time it takes for a wounded veteran to see a VA doctor. More than 200,000 veterans are homeless in America, and over 600,000 veterans are still waiting in line for the VA to decide their claims. And now the VA says that veterans must take their complaints to Congress, when it is the VA, not Congress that is the problem,” Sullivan added.

Many veterans who have fought in Iraq and/or Afghanistan are not being given the disability compensation, medical services and care they need. A much higher percentage of these veterans suffer with Post Traumatic Stress Disorder ("PTSD") than veterans of any previous war, due to the multiple tours many are serving, the unrelenting vigilance required by the circumstances, the greater prevalence of brain injuries caused by the types of weaponry in use, among other reasons.

In spite of this, the Department of Veterans' Affairs ("DVA") is failing to provide adequate and timely benefits and medical care. This federal lawsuit, on behalf of veterans with pending claims based upon PTSD, regardless of the conflict in which they served, is for declaratory and injunctive relief, based primarily on the due process clause of the Constitution. We will focus on the following issues:

* The widespread breakdown of the DVA's adjudication and health care systems for veterans experiencing PTSD. For example, the application process is too complicated; even veterans with "successful" claims are given ratings that are too low; veterans who are rated as disabled continue to be denied appropriate medical care and ongoing support;

* The prolonged administrative delays in processing PTSD claims, at both the regional office and appellate levels. Applications are often bounced up and down through a complicated appeals process. We estimate that the average time for a claim to go through the entire appeals process, from the Regional Office to a petition for certiorari to the Supreme Court, is between twelve and fifteen years;

* A variety of statutory and regulatory impediments to a veteran's ability to collect PTSD compensation. These include the inability to obtain discovery, the absence of subpoena power for documents and witnesses, and the inability to hire a lawyer to help out at the regional office level, among other impediments; and

* A pattern and practice of internal DVA abuses and improper rules. These are difficult to detect or prove without discovery.

[UPDATE Sept 29, 2007]: Received the following details via email from Melissa Kasnitz, Disability Rights Advocates managing attorney working on this case:

The VA, represented by the U.S. Department of Justice, has filed a motion to dismiss the entire case, and claimed that veterans have no recourse in the courts for any of the problems we identified.

They also specifically argue that VA is not obligated to provide 2 years (or any) healthcare for veterans, because the relevant statute has a limitation based on appropriations. The short version is that they are arguing that it doesn't matter that the system is broken, and the courts can't make them fix it.

Of course we will be opposing the motion, which will be heard on November 2 by the judge in San Francisco. ... [The] DOJ is arguing on behalf of VA that there really is no obligation to provide any true support for veterans.

Wednesday, September 26, 2007

The largest Iraq and Afghanistan vets' group in the country, IAVA, has been busy working to get returning troops the benefits they've earned and the respect they deserve. [To learn more about their work, read a recent Pioneer Press feature.]

Last week, they delivered that 25,000+ strong petition to members on Capitol Hill. But, it's not too late to join with them and add your own name to the list. Simply click on the flash icon to your right to go to the This Is For the Soldiers website.

The band's current single "Soldiers" pays homage to our Armed Forces and their current "This Is For The Soldiers Tour" [dates] donates fifty cents of every ticket sold to IAVA and fifty cents to the USO, while encouraging young fans to support the cause.

The band is a favorite of U.S. servicemembers, and has performed USO tours in Iraq, Kuwait and South Korea. Drowning Pool's lead vocalist Ryan McCombs said "It's an honor and a privilege to work on something as important as this legislation."

The Lane Evans Bill would help troops and veterans get mental health care in the following ways:

* Require in-person mental health screening for returning combat veterans* Extend the window of eligibility for mental health treatment from two to five years* Establish a registry to monitor the health of Iraq and Afghanistan veterans and track their benefits use* Improve the transfer of military records from the Department of Defense to the Department of Veterans Affairs

Drowning Pool released Full Circle on August 7th on Eleven Seven Music. KNAC.COM Correspondent Deb Rao spoke to Drowning Pool guitarist C.J. Pierce in Cambridge. When asked how the tour was going, Pierce said:

“The tour is going great. It doesn't matter whether we are playing to 50 people or 10,000 people. Every day is different; today is a Monday so the crowd is different from a Friday or Saturday night. What matters are the fans and the people who come to see us that are fighting for our country?

I recently played for our troops over in Iraq, and there wasn't a greater feeling in the world to give to the men and women the gift of metal. We played for two hours, and the troops were so happy to hear the music. They have our song, "Bodies" being played in the training camps. I have seen the condition some of the men and women are in, when they return home and while performing in Iraq. Drowning Pool is donating a dollar from every ticket sale to the Veterans, so they can get a prosthetic leg. Stevie, our bass player's father is a Veteran.

I am 35 years old, and I can't say I have seen it all. But I have seen a lot. I have seen what the Soldiers are going through. This tour is to give the Veterans better health care, when they return home. This is not a political campaign or tour. It is for our troops. Drowning Pool visited Capital Hill last week. We got 25,000 signatures in support of the Lane Evans Bill. We met with Hilary Clinton and Obama.

I live in Texas, and I am originally from New Orleans. The best part about being on tour is going home and performing to your hometown fans. This tour is all about family and our Brothers and Sisters, and our Troops, who deserve to have better healthcare when they return home. Drowning Pool will be visiting the Troops Overseas in January. We don't know yet what bases, but I will keep you informed. Thank you for all of your support.”

Drowning Pool's "Soldiers" video includes footage from their last Iraq and Kuwait tour:

While their musical style may not be for everybody, their heart sure is in the right place. Rock on, Drowning Pool and IAVA!

Dr. S. Ward Casscells, assistant defense secretary for health affairs, said that the military is committed to making the changes needed "to provide the highest possible level of care and support to our military community." But the military will not rush the reforms and run the risk of "ineffective reactions," the report said.

Among the reforms that the Defense Department won't rush are improvements in the psychological screening of active-duty troops. The task force had recommended that all service members undergo an "annual psychological health needs assessment," conducted by a trained professional who would promptly refer troubled troops to mental health clinicians.

Gates' office said that the military will expand annual health screenings to ensure that troops' mental well-being is evaluated, but the report did not offer specifics, and it set a completion date of "beyond May 2008." The report said that the changes in screening would be made gradually, during a "three-year evaluation project."

Similarly, the Defense Department said that it was working to put in place psychological screening for new recruits, as the task force recommended, but that change also is months away.

Of course, things in a large organization like the military can't change overnight. But delays in implementing the Dole-Shalala Commission recommendations translate to very real hardships for our military families who have already had to endure a lot.

Soldiers' advocates and some members of Congress have been calling for tighter pre- and post-deployment psychological screening of troops for more than two years - before the task force was created by Congress.

Last year, a series in The Courant that detailed lapses in the screening and treatment of soldiers with psychological problems - sometimes with tragic consequences, such as suicide - prompted Congress to push for improvements in care. In response, the Defense Department issued new guidelines last winter that set standards for deciding whether service members with psychiatric problems should be deployed and kept in combat.

In the new report to Congress, the Defense Department said that efforts to improve mental health "early intervention" have been hampered by a lack of resources.

"Although we have put in place some early intervention practices, such as our deployment health assessment and education programs, most prevention and protection efforts have come at the expense of clinical care, calling on our clinicians to do `double duty,'" the report said. "In the long-term, this business practice is unsupportable and ineffective. A change is clearly needed to make psychological fitness an equal priority to psychological treatment."

In the report, the Defense Department said that it will soon hire up to 200 military mental health professionals to work on stateside bases, to begin to ease a shortage that the task force called critical. The Army also is in the process of hiring about 260 civilian behavioral-health care workers, officials said.

With the shortfalls, it's no wonder that the military is having a hard time meeting the needs of physically or psychologically wounded returning veterans.

The Army announced in June it would hire 200 civilian psychiatrists, psychologists, psychiatric nurses and social workers. It later raised that to 265, a 23% increase in those job categories for the Army. By last week, the Army had filled 40% of the jobs. ...

The shortage in Army uniformed therapists is having an impact on the Iraq war, where Navy and Air Force counselors are helping the army treat soldiers. The number of mental health providers has not kept pace with the additional 30,000 U.S. troops sent to Iraq this year, according to Army statistics provided to USA TODAY. In addition, the Army says some mental health counselors are burned out by their war experience.

"Medical providers are fatigued by the strains of the caring for injured soldiers and soldiers suffering from the psychological effects of deployment, including PTSD," says Col. Elspeth Ritchie, psychiatric consultant to the Army surgeon general, referring to post-traumatic stress disorder. "We are planning to put additional providers at each major installation specifically to support providers."

Experienced therapists continue to leave the military for better-paying and less stressful jobs in the private sector. The Navy, for example, expects to lose a dozen of its 88 psychiatrists this fiscal year and 25 of 116 psychologists, according to data released at a Marine Corps conference in June. Incentives have been created to keep or recruit new psychiatrists and psychologists, including retention bonuses and college loan repayment offers. ...

The Army is preparing a recruiting program aimed at older physicians and mental health providers, aged 48 to 60. They would allow for enlistments of only two years, Army Col. Larry Bolton says.

Meanwhile, the level of mental health care in the Iraq war zone — as a ratio of providers to troops — is the lowest since 2004, Army statistics show. Care has dropped from one counselor per 668 troops last year to one for every 743 this year.

Many of the current [Warrior Transition Unit] staffers, said John Pendleton, author of the report, are borrowed, presumably temporarily, from other offices. Ultimately, hundreds more nurses, social workers and mental health specialists will be needed to handle such issues as traumatic brain injuries and post traumatic stress disorder, he said.

The GAO also noted that the Pentagon and the Veterans Affairs Departments were behind schedule in starting a pilot program under which the two departments would adopt a single medical examination and a single disability rating performed by the VA.

"We are seven months into this process and we are just now getting off the ground," said Rep. John Tierney, D-Mass., chairman of the Oversight and Government Reform subcommittee on national security. "Why has it taken so long to get going on that?" ...

Retired Adm. Patrick Dunne, the VA's assistant secretary for policy and planning, told the hearing that the pilot program to set up a unified disability evaluation system should be completed by the second quarter of 2008. If successful, it will be expanded beyond the Washington capital region to become universal.

Rep. Tom Davis, R-Va., top Republican on the panel, said his office hears every week from wounded soldiers stuck in an evaluation system they don't understand and that is complicated by different ratings coming out of the Defense Department and the VA. "Having to run that double gauntlet causes additional pain and confusion, literally adding insult to injury. That has to stop."

While efforts are under way to respond to both Army-specific and systemic problems, challenges are emerging such as staffing new initiatives. The Army and the Senior Oversight Committee have efforts under way to improve case management--a process intended to assist returning servicemembers with management of their care from initial injury through recovery.

Case management is especially important for returning servicemembers who must often visit numerous therapists, providers, and specialists, resulting in differing treatment plans. The Army's approach for improving case management for its servicemembers includes developing a new organizational structure--a Warrior Transition Unit, in which each servicemember would be assigned to a team of three key staff--a physician care manager, a nurse case manager, and a squad leader.

As the Army has sought to staff its Warrior Transition Units, challenges to staffing critical positions are emerging. For example, as of mid-September 2007, over half the U.S. Warrior Transition Units had significant shortfalls in one or more of these critical positions. The Senior Oversight Committee's plan to provide a continuum of care focuses on establishing recovery coordinators, which would be the main contact for a returning servicemember and his or her family. This approach is intended to complement the military services' existing case management approaches and place the recovery coordinators at a level above case managers, with emphasis on ensuring a seamless transition between DOD and VA.

At the time of GAO's review, the committee was still determining how many recovery coordinators would be necessary and the population of seriously injured servicemembers they would serve.

As GAO and others have previously reported, providing timely and consistent disability decisions is a challenge for both DOD and VA. To address identified concerns, the Army has taken steps to streamline its disability evaluation process and reduce bottlenecks. The Army has also developed and conducted the first certification training for evaluation board liaisons who help servicemembers navigate the system.

To address more systemic concerns, the Senior Oversight Committee is planning to pilot a joint disability evaluation system. Pilot options may incorporate variations of three key elements: (1) a single, comprehensive medical examination; (2) a single disability rating done by VA; and (3) a DOD-level evaluation board for adjudicating servicemembers' fitness for duty. DOD and VA officials hoped to begin the pilot in August 2007, but postponed implementation in order to further review options and address open questions, including those related to proposed legislation.

Fixing these long-standing and complex problems as expeditiously as possible is critical to ensuring high-quality care for returning servicemembers, and success will ultimately depend on sustained attention, systematic oversight by DOD and VA, and sufficient resources.

Worthy of repeating the bottom line once more: Sustained attention, systemic oversight, and sufficient resources are the keys to success for our returning troops.

Judging by the sexy avatar to the left here, the tagline for tomorrow night's interview on Second Life's "Virtually Speaking with Jimbo Hoyer" show should be: "If I looked this good in the real world, I wouldn't have any problem 'moving a nation (of men) to care'!"

That in mind, I'd really like to thank Jane at InWorld Studios for creating this, uh, realistic avatar of me for tomorrow night's interview (my official Second Life name is IlonaMeagher Underwood), and I'd also like to thank Jay and all the rest of the gang for inviting me on. Looking forward to it!

Second Life is a 3-D virtual world entirely built and owned by its Residents. Since opening to the public in 2003, it has grown explosively and today is inhabited by a total of 9,708,801 Residents from around the globe.

We are a global community working together to build a new online space for creativity, collaboration, commerce, and entertainment. We strive to bridge cultures and welcome diversity. We believe in free expression, compassion and tolerance as the foundation for community in this new world.

To see how art and the digital world come together in SL, take a minute to watch a short showcase video. Details:

In August 2006, Suzanne Vega became the first major recording artist to perform live in Second Life avatar form. This forms part of a larger project sponsored by The Infinite Mind, a public radio show which has hired Infinite Vision Media to create a permanent presence in Second Life.

Robbie Dingo was commissioned by Boliver Oddfellow (CEO, Infinite Visions) to make the Guitar and animation for the Vega avatar (created by Munchflower Zaius). The following is a fantastic short video that shows Robbie's considerable building skills at work while he whips into shape a lifelike replica of Suzanne Vega's guitar for the event.

While I haven't had a guitar created for me, I'm flattered to see how I turned out in digital form. As I said, if I looked like this in the real world, I don't think I'd have a problem 'moving a nation (of men) to care' about the issue of combat PTSD!

Following the defeat of the politically-charged Webb-Hagel 'Dwell Time Amendment' earlier this month, the idea gains another unlikely supporter. From the Washington Post:

Army Chief of Staff George W. Casey Jr., who is scheduled to testify today before the House Armed Services Committee, intends to move as quickly as possible to grant soldiers more relief from the war zone, having argued that the troop rotations of 15 months in combat and 12 months at home -- required by the buildup of U.S. forces in Iraq and the conflict in Afghanistan -- are "not sustainable" for the Army.

Army planners are considering options for how to use the withdrawal of five Army combat brigades from Iraq by next July to increase the time that soldiers spend at home compared with the time on the battlefield. The reduction is part of the drawdown of 21,700 combat troops that President Bush announced this month. Requiring equal time deployed and time at home was a key aim of Democratic legislation that failed last week in Congress.

"The Army . . . is trying very hard to reduce the amount of time deployed versus the dwell time back in the United States, trying to get to a 12-month deployment to a 12-month dwell time back at home station," said Maj. Gen. Richard Sherlock, director of operational planning for the Joint Chiefs of Staff, said at a Pentagon briefing yesterday.

Click on 'Article Link' below tags for more...

Continuing:

Casey and other members of the Joint Chiefs have made no secret of their concerns about the stress imposed by the troop buildup. "Now we're 15 out, 12 back. And that's not sustainable," Casey said at a forum earlier this month. "I do not want to go beyond 15 months on the ground for the soldiers, and I want to get to more than a year at home as rapidly as we can," he said. Asked whether he thought the troop increase was working, Casey, who until this spring served as the top U.S. commander in Iraq, replied: "It remains to be seen." ...

Rep. Solomon P. Ortiz (D-Tex.), chairman of the readiness subcommittee of the House Armed Services Committee, said Army generals have told him privately that the Army cannot maintain its current pace of war-zone rotations. "They are saying it's almost to the breaking point, we can't continue on this path," he said in an interview.

Committee Chairman Ike Skelton (D-Mo.) has warned that the demands of Iraq and Afghanistan have left the Army short of vital manpower, equipment and training for other overseas contingencies.

"No one can disguise the fact that the Army's ability to project forces is nil. They are not ready for full spectrum combat and it's recognized now," said a U.S. official who spoke on the condition of anonymity because he was not authorized to talk to reporters.

Army officials said that in addition to addressing ways to reduce stress on the force, Casey and Geren will attempt to impress upon lawmakers that the Army's need for billions in additional funding will continue long after tens of thousands of soldiers return from Iraq.

"We're trying to inform Congress about the Army's future funding problems," said one senior Army official. "We've got to recapitalize our whole armor fleet. Tanks and Bradleys have been eaten up to no end. We have to replace the pre-positioned equipment" of stocks stored overseas, the official said. "That's something no one likes to talk about."

The Fleet Reserve Association (FRA) has launched an online survey for active duty and Reserve enlisted personnel in the Navy, Marine Corps and Coast Guard, to determine the quality of family readiness in the sea services. The survey can be found on the home page of FRA’s quarterly OnWatch publication, www.fra.org/onwatch [or directly here].

“Family readiness is a top priority for FRA and military personnel, and their families need to be completely familiar with resources available to them,” said FRA’s National Executive Secretary Joe Barnes. “Family readiness is even more important during frequent deployments which can take a toll on service members and they must have the best support possible.”

Click on 'Article Link' below tags for more...

Continuing:

In the survey, FRA asks for input on family readiness issues including health care benefits, financial readiness and the education available regarding Post Traumatic Stress Disorder (PTSD). The questions range from “Have you ever been briefed on high interest, short-term payday loans”, to “How do you rate your awareness of health care benefit options and counseling?” The Association’s number one legislative priority is health care, working to keep TRICARE costs down and ensuring there is adequate access to care. FRA also led the fight against high interest, short-term “payday loans,” which set up facilities near military bases, preying on service members with promises of “instant cash.” Lastly, the Association strongly supports wounded warrior legislation and funding for PTSD.

FRA’s survey results are used in a number of ways. The Association’s legislative team takes the results and shares them with Congress, whether directly referenced in testimony, or in tailoring their legislative agenda. The editorial team also shares the data with the senior enlisted leaders of the Navy, Marine Corps and Coast Guard. The E-10’s offer their input in interviews for OnWatch online. Visit www.fra.org/onwatch to read the current article and results from the previous online survey.

FRA is a congressionally chartered, non-profit organization representing the interests of current and former enlisted members of the Sea Service community, including the U.S. Navy, Marine Corps and Coast Guard. In addition to its advocacy work on Capitol Hill in support of enlisted personnel, FRA aids its members with career issues by maintaining close relationships with government agencies and by educating lawmakers about the challenges facing those who serve in the armed forces. The Association also awards scholarships totaling nearly $100,000 annually, sponsors a national essay contest, and assists its members with disaster relief grants.

Tuesday, September 25, 2007

Today, the John D. and Catherine T. MacArthur Foundation will announce that [Jonathan] Shay, 65, has been selected as a 2007 MacArthur fellow "for his work in using literary parallels from Homer's 'Iliad' and 'Odyssey' to treat combat trauma suffered by Vietnam veterans."

"His work is important for delivering healthcare to all those who put their lives on the line in the service of our country," said Mark D. Fitzsimmons, associate director of the MacArthur Fellows Program. "It's fair to describe it as pertinent."

Click on 'Article Link' below tags for more...

In the interest of education, article quoted from extensively.

Continuing:

Shay grew up in the suburbs of Philadelphia, attended Harvard College and the University of Pennsylvania, and ran a laboratory at Massachusetts General Hospital, studying the biochemistry of brain cells and why they die so fast after a stroke.

Then, at the age of 40, Shay had a stroke. He went into a coma for several days and emerged temporarily paralyzed on the left side of his body. It took him a year to recover fully. While he was convalescing, Shay "decided to plug up the holes in my education" and read the English translations of the "Iliad" and the "Odyssey."

In 1987 Shay went to work for the Department of Veterans Affairs Outpatient Clinic in Boston, hoping to open a lab and restart his research career. In return, Shay, a psychiatrist, agreed to work as a counselor "at a very grimy, dilapidated day hospital on the top floor of a garage building on the edge of Chinatown here in Boston."

Almost immediately, psychiatry became the main focus of his work, and he soon found that the veterans he treated trusted him and responded to his counseling in ways he had not expected.

"The veterans simply kidnapped me," he said. "They saw something in me that I didn't see in myself, and they utterly redirected my life."

As he listened to the veterans during his sessions, he realized that the psychological trauma that haunted the veterans of the Vietnam War had also tormented the heroes of the Greek epics.

Springing from that realization are two unique volumes:

Soon, Shay began to work on his first book, "Achilles in Vietnam: Combat Trauma and the Undoing of Character." In the book, he interspersed the story of Achilles with examples of his patients' losses and contentious relationships with their commanders in Vietnam to illustrate some of the causes of the troops' psychological wounds.

Shay's books are "a wonderful resource for both clinicians and vets and their loved ones," said Keith Armstrong, a San Francisco psychiatrist and one of the authors of "Courage After Fire," a guide book on coping with trauma for troops who are returning from Iraq and Afghanistan and for their families.

Shay wants to study how to improve the way the military treats the troops and their needs at a center he hopes to open at the John F. Kennedy School of Government at Harvard.

It's been about 16 weeks since "Moving a Nation to Care" was released, and I thought it might be a good time to stop and do a quick review of our progress. In the grand scheme of things, of course, this is merely a bit of navel-gazing; but, so many of you can take credit for putting these things into motion that it's only natural I'd want to share some of our accomplishments. To everyone involved in this project, thank you.

It's been a remarkable journey for this 'citizen journalist' -- one that would not have happened were it not for everyone's combined effort and energy.

Sunday, September 23, 2007

A stunningly written piece by the Gary Post-Tribune's Jerry Davich shares the story of a six-tours-in-Iraq medic that hits many of the notes that we've heard so much about with combat PTSD. But the song played this time is especially moving since our protagonist received his psychological wounds while saving the lives of many of our most physically wounded soldiers.

Fortunately, this military family says their local VA is doing tremendous work with them, which is absolutely wonderful to hear.

Kim Cox choked up before her husband could reply. She knew his feelings all too well.

"Even knowing the outcome and problems I have now," Cox said, staring past Kim, "I'd do it all over again, no doubt about it."

David reached for a sip to drink. Kim reached for a Kleenex.

Since the war in Iraq began, David has served six tours of duty as a critical care nurse for the Indiana Air National Guard. He helped transport roughly 500 critical patients during 156 combat missions, body after body, death after death.

It all caught up to him earlier this year.

Click on 'Article Link' below tags for more...

In the interest of education, articles quoted from extensively.

Continuing:

Cox, a staunch supporter of the war from day one, lost 57 pounds in one month while in Iraq. That's when he stopped sending photos of himself back home to Kim. That's when he couldn't shake the nightmares and the sadness. That's when Kim knew something was wrong with her husband of 30 years but couldn't do anything from 7,500 miles away. ...

After finally arriving home in June -- he's been home only nine months in the past four years -- he went away once again, but this time for residential treatment in an out-of-state military medical facility. There he talked with other soldiers with PTSD. It helped. It healed. But it's only a start.

It pounds away at the 56-year-old Indiana Air National Guard critical care nurse with repeated rounds of depression, anxiety, panic, jumpiness, agitation, you name it.

He received psychological care while in Iraq, but the constant mortar shelling and combat missions didn't help his treatment. Plus, this past 10-month tour, the last of six since the war began, was his busiest and deadliest. Back and forth from Balad to Germany, patient after patient, body after body.

In May, while aboard a flight for the United States from Qatar, his emotions ambushed him again and he had to be hospitalized there, delaying his homecoming. He finally returned here late last month.

The reporter shares his experience of the heroic, human medic:

I first wrote about Cox in 2003, just after the Iraq War began.

I first met him in 2005, soon after he returned home from his second tour of duty.

In his basement, standing in front of two American flags draping the walls, each with handwritten notations of the combat missions he has performed, I remember asking Cox how he's able to emotionally absorb all the wounded, dying, and sometimes dead U.S. soldiers he transports.

How, I asked him in 2005, does he deal with this, one bloody or burned body after another, over and over, mission after mission? In his calm voice and low-key demeanor, the graying father of three told me simply, "It's what I do."

Since then, Cox has always represented to me what's good about a bad war, what's right about a wrong decision, and what's best about a worst situation. Oh, and along the way he helped rescue an Air Guard record 450 soldiers during 156 combat missions.

So when Kim e-mailed me saying David was coming home last month, I didn't think anything of it. I figured the Air National Guard's true iron man, the son of a U.S. Air Force retiree, would return to the region unscathed, again, after dodging so many proverbial bullets.

Well, I was wrong.

He got hit -- in his psyche -- by all the combat tours, the human carnage, and the unspeakable images he witnessed.

"I guess it finally caught up to me," Cox told me.

Cox and his family are now busy getting their lives back together, seeking the the peace and contentment that they deserve after the many great sacrifices they've made in peace-of mind.

David spends his time getting accustomed to civilian life again. The simple pleasures of grocery shopping with Kim, drives in the car with their dog Murphy, or doing absolutely nothing but watching life's wheels go 'round and 'round.

But the couple never knows what will trigger David's PTSD -- sometimes a photo of the war, sometimes a news account, sometimes a harmless TV show showing a doctor giving a patient a shot. And sometimes the trigger comes from within -- a memory, a flashback, an unexplained sense of dread.

Kim uses the word "sickness" to describe her husband's condition. "It's a mental illness, a disability," she explained. But David doesn't use that term. He calls it a sadness. "Knowing I'm not going back helps a lot," he said. "I don't want to see sand or 130-degree heat for a long time. I don't miss it at all."

The Cox family uses jokes and humor to bind them together but also to deflect the hard times these past few months. They laugh more than cry, they smile more than they frown.

"So many others came back in a lot worse shape than me," David said matter-of-factly, "with one less arm or leg or eye. I have no right to complain."

Last year, Kimberly Cox wrote the Chicago Sun-Times about her husband during the paper's 'Yellow Ribbon Week' remembrance of the third year of the Iraq War:

My husband, Maj. David Cox, is currently serving his fourth deployment in support of Operation Iraqi Freedom. He is 56 years old. We have been married 28 years. David's military career began at the tail end of Vietnam. He jokes that it is the only lottery he ever won.

After finishing college, he left the military for a civilian nursing career. The military never left his thoughts, and in 1998, he decided to come back in, joining the Air National Guard. He received his commission and is based with the 122nd out of Fort Wayne.

They knew on 9/11 that their lives would be changed forever:

David's alert started that day.

When he was deployed the first time, we didn't know what to expect. I don't really want to say that we are used to it by now, but we do know what to expect. We know that sacrifices have to be made, and we both feel our sacrifices are small compared to what others have had to give.

In the past four years we have had only one holiday season together. This past year was the first time we were together in three years for our anniversary. When our daughter got married, we didn't know until two weeks before her wedding if her dad would be there to walk her down the aisle. He left two days after her wedding. He was not here when our first grandchild was born.

That being said, we feel blessed to be a part of helping the spread of democracy in the world. We both truly believe in our country's missions in Iraq and Afghanistan.

It is difficult to be apart so much. I think the hardest thing is just not being able to talk to each other whenever you feel like it. I miss my husband, but I try very hard to act with dignity and support him. He can't do his job correctly if he has to worry about me falling apart. That could endanger his life and the lives of those entrusted to his care.

Kathie Costos over at Wounded Times wrote a thoughtful intro to the Post-Tribune piece when she shared it with her readers tonight:

I keep trying to tell veterans that PTSD does not care if they support the mission they were given or not, support Bush or not, because in the end, that really doesn't matter. What matters is they were a human willing to serve. PTSD only cares that it can feed off of trauma and it doesn't get more traumatic, more horrific than combat. It doesn't know if the person held a gun, had the gun pointed at them or cleaned up after the shooting and blowing up stopped. ...

David Cox served six tours as a nurse in Iraq. Even now as you will read, he would go back if he could. So please stop letting people get away with attacking combat veterans with PTSD as being cowards, being lazy, being "un-patriotic" or all just being against Bush. Don't pass them off as if no one pays attention to them because people do. It has nothing to do with character, being brave or anything else because it comes to people from all sides. It is nothing to be ashamed of because they are wounded humans who survived an abnormal situation. Can you get more abnormal than combat?

They do not all end up with the same level of PTSD and they do not all end up snapping or committing suicide. Sadly they do not all heal either. Some never seek the help they need. They just need someone to reach out to them as one human to another human. No politics and no judgments. Just help.

Sending my very best wishes to the entire Cox family. And a big thank you to the great reporting of the Post-Tribune.

The U.S. Department of Veterans Affairs Office of Inspector General released an audit [pdf] earlier this month revealing a far less successful level of service is provided to its clients than has been reported to Congress. From the Seattle Times:

The VA overstated to Congress how quickly it cares for veterans, understates how many are waiting for care and may be "gaming" its own system to show better results, according to an internal investigation.

The review by the VA inspector general's office, released Monday, examined 700 outpatient appointments for primary and specialty care scheduled in October 2006 at 10 VA medical centers.

Three-fourths of veterans were seen within the required 30 days, far fewer than the 95 percent claimed by the Department of Veterans Affairs. Of the veterans kept waiting more than 30 days, 27 percent had more serious service-connected disabilities, such as amputees and those with chronic problems including frequent panic attacks. Under Veterans Health Administration (VHA) policy, such patients must be scheduled within 30 days of their desired appointment date.

Click on 'Article Link' below tags for more...

Continuing:

In addition, despite warnings by the inspector general in 2005 to more accurately report wait times, department officials last year also may have understated the number of veterans on their electronic waiting lists by more than 53,000.

"While waiting time inaccuracies and omissions from electronic waiting lists can be caused by a lack of training and data-entry errors, we also found that schedulers at some facilities were interpreting the guidance from their managers to reduce waiting times as instruction to never put patients on the electronic waiting list," VA investigators wrote.

"This seems to have resulted in some 'gaming' of the scheduling process," the 34-page report said.

VA undersecretary for health Michael Kussman partly agreed that the agency should take additional steps to improve scheduling with better training, procedures and accounting of records. ...In April, Kussman testified to Congress that 95 percent of veterans were receiving the timely appointments. The VA's 2006 annual report, issued last November, makes similar claims.

The department also is struggling to reduce a severe backlog of disability payments, with delays of up to 177 days to process an initial claim...The VA medical facilities reviewed in the inspector general's report were for both primary and specialty care in Birmingham, Ala.; Atlanta; Columbia, S.C.; San Antonio, Temple and Dallas in Texas; Cincinnati; Detroit; Indianapolis; and Chillicothe, Ohio.

This past week, a week after the audit results were released, the Associated Press reported on Nicholson's Congressional testimony:

Outgoing VA Secretary Jim Nicholson acknowledged Tuesday that he's struggling to reduce backlogs in disability claims from Iraq war veterans, saying current efforts won't be enough to cut down waits that take months.

Addressing Congress for a final time before stepping down Oct. 1, Nicholson also pointed to persistent problems between the Pentagon and Department of Veterans Affairs in coordinating care for veterans and urged Congress to embrace proposals by a presidential commission to fix gaps.

"They have some very good ideas in there," he said.

Nicholson's testimony to a House Veterans Affairs Committee painted a mixed picture of a VA that has initiated measures to boost mental health and other care but has struggled to keep up with growing demands due to a prolonged Iraq war.

Nicholson, who took office in early 2005, said the department has hired 1,100 new processors to reduce delays of up to 177 days in processing disability payments. But he predicted another rise in compensation and pension claims this year, citing the additional applications pouring in during "the midst of war."

The increase, he said, is coming from Iraq war veterans as well as veterans from previous conflicts who were prompted to file additional claims for new or additional benefits amid the current public focus on war-related injuries in Iraq.

Even with new staff, the VA can only hope to reduce delays to about 145-150 days — assuming that the current level of claims doesn't spike higher.

At the same time, Nicholson acknowledged continuing problems that will fall upon his yet-to-be-named successor and expressed sympathy to injured veterans who might have unfairly suffered as a result of unnecessary red tape.

"We have learned that, in many instances, we were not as sensitive to those needs as we could have been — and we have tried to adjust, while at the same time caring for veterans of different wars and different eras," Nicholson added in written testimony. "My heart has gone out to service members or veterans who seem to have slipped through the cracks."

Separately, Nicholson also called for creation of a new VA assistant secretary position for acquisition and construction to oversee billions of dollars of purchases for VA facilities. On average, VA buildings are 57 years old, and the cost of purchasing land, design and construction of a new hospital costs about $750 million.

"The magnitude of these numbers and the complexity of the acquisition process indicate that there must be the very highest levels of supervision and accountability," he said.

Among the achievements Nicholson cited:

_Launching a campaign to reduce high rates of obesity and diabetes in veterans. Some 25 percent of veterans under VA care suffer from adult-onset Type II diabetes, which can lead to blindness, renal failure or amputations.

_Creating a new multi-campus academy in partnership with U.S. nursing schools to address a nursing shortage and encourage nurses to work for the VA.

_Hiring suicide prevention counselors at each of VA's 153 hospitals and creating a 24-hour prevention hotline in July.

_Centralizing the VA's information technology system to minimize the risk of data loss. That came after nearly 26.5 million veterans' personal information was put at risk of identity theft last year after a VA employee lost a computer hard drive.

Not everyone, however, is singing Nicholson's praises.

Dan Moffet writes a searing Palm Beach Post opinion piece today on who might be President Bush's worst political appointee:

The dark horse in the race for most incompetent appointee (MIA) is Veterans Affairs Secretary Jim Nicholson, who is leaving office Oct. 1 after an impressive 32-month run of sustained ineptitude.

Mr. Nicholson made himself a contender with an eclectic display of bad management and indifference toward veterans' needs: He was $1.3 billion short on his first budget. He oversaw the debacle over outpatient conditions at Walter Reed Hospital. He gave $3.8 million in bonuses to VA administrators while soldiers returning from Iraq waited and waited and waited to see doctors. He allowed the theft of 26.5 million vets' personal data because of inadequate security controls over laptop computers. ...

Mr. Nicholson, who got his job as a reward for serving as the Republican National Committee chairman, made what should be his final appearance before Congress last week. Predictably, it was another embarrassment.

Members of the Senate Veterans Affairs Committee listened with appropriate skepticism as Mr. Nicholson tried to dismiss the results of a VA inspector general's report released this month. The auditors examined hundreds of outpatient appointments for care at 10 VA medical centers. The investigators found that the VA was consistently distorting its record on wait times for injured and ailing veterans. ...

The numbers that Mr. Nicholson was able to get right are discouraging as ever. He admitted that the VA has been unable to make progress in reducing the backlogs of disability claims, a chronic problem that has been exacerbated by veterans returning from Iraq and Afghanistan with physical and mental injuries. Vets still have to wait about six months to get rulings on their claims.

Granted a 30-day leave to prepare for retirement as his disability case finally made it through the system, [Staff Sgt. John Daniel Shannon] moved his family to Suffolk, Va., and began to babysit his two kids, clean the house and grow vegetables. Given what had happened to him in Iraq -- the traumatic brain injury from an AK-47 round that shattered one eye and half his skull -- and the chronic post-traumatic stress disorder that followed, that was about all he could handle.

Last week, Shannon, 43, was back at Walter Reed, but not to say goodbye. The doctors' signatures on two time-sensitive forms in his disability file had expired. He would have to be reexamined by his doctors, he was told, and his medical summaries would have to be written all over again. Unfortunately, the sergeant in charge of his disability paperwork had not stayed on top of his case. ...

After a Washington Post story in February described the conditions that Shannon and other wounded soldiers at Walter Reed endured after returning from Iraq, Shannon became something of a spokesman for his fellow patients.

He testified before a congressional hearing about the Army's obligation to care for its wounded. Members of Congress and generals shook Shannon's hand and thanked him for his courage, while President Bush and Defense Secretary Robert M. Gates promised swift changes. Three panels were set up to study not only Walter Reed's failures, but the entire overburdened military medical-care system for returning soldiers and Marines five years into war.

But none of that kept Shannon from getting caught up again in military bureaucracy.

"It's like being kicked in the teeth by a horse," Shannon said this week in a phone interview, alone in his room at Walter Reed. "I've been sitting here for three years. I don't even know what 'going on with my life' means. I want to scream at the top of my lungs. I'm at the end of my rope."

Two years ago, Army Specialist Ronald Hinkle left a good trucking job, a working ranch, a wife and two daughters in Byers, Colo., to serve in Iraq. Now Hinkle is one of more than 13,000 American service men and women who have suffered serious wounds in the wars in Iraq and Afghanistan. Hinkle survived an IED blast but festering wounds nearly killed him. He and his family are struggling to rebuild lives completely transformed by that explosion in Iraq.

Hinkle was diagnosed with Traumatic Brain Injury, or TBI, as a result of the IED explosion. He suffers from sudden seizures. He tires quickly. He doesn't think clearly, and he cannot be left alone.

Hinkle was honored for his service in November when Vice President Dick Cheney pinned a Purple Heart to his desert fatigues, but his family feels otherwise deserted by the Army. The U.S. Army failed to provide all the benefits and support for which the family is entitled. Now the Hinkles are tens of thousands of dollars in debt, and they may lose their ranch. Ron's wife, Reece, gave up her lucrative income as a corporate accountant to take care of him.

Reece now finds herself as more of a caretaker than wife, and she laments that Ron has lost the ability to be a father, a son and a husband because "he is living his life being injured."

"Just trying to just figure out how to deal with that is enough," Reece said. "What people don't realize is it's not the injury that destroys families. It's the aftermath. It's how you reconstruct your life, how you physically regroup, emotionally, financially. It will never be the same."

As the critically-acclaimed documentary, "Alive Day Memories: Home from Iraq," continues to air on HBO in its various formats through November 1 (full schedule), Ken Burns delivers a penetrating look at the sacrifices of the WWII generation on PBS in a seven-part series beginning tomorrow.

Ken Burns, one of America's greatest visual historians, unveils his most ambitious television project yet on Sunday, a seven-part, 15-hour documentary that tells the story of World War II "from the bottom up."

Six years in the making, "The War" explores one of the most devastating episodes in human history from a purely American perspective, as told by dozens of otherwise ordinary men and women who lived through the conflict.

Absent from the $13 million PBS series are the scholars, generals and other historical figures whose testimonials typically provide a foundation for such documentaries, as they did in Burns' 1990 epic examination of the U.S. Civil War.

"It was our conscious decision to do this entirely from the bottom up," Burns said in an interview. "And that meant if you weren't in this war, or you weren't waiting anxiously for somebody to come back from this war, you're not in our film."

With members of America's "Greatest Generation" dying at a rate of more than 1,000 veterans a day, Burns raced the clock to assemble his first-person account of the war.

The series looks at the Second World War through the experiences of four U.S. towns: Sacramento, Calif.; Mobile, Ala; Luverne, Minn.; and Waterbury, Conn., thereby touching a chord with hundreds of small communities that don't often find themselves in the spotlight.

Burns takes a bottom-up approach, building the series from interviews with dozens of men and women from the four towns, those who departed to fight in the European and Pacific theatres as well as those who were left minding the home front. And though Burns completed most of the interviews before the U.S. invaded Iraq in the spring of 2003, his emphasis on the common soldier, rather than the celebrity generals or glad-handing politicians, seems especially prescient, given the current desire of the U.S. public to support the troops on the ground but challenge its leaders.

The War notes how many of the boys - and they were indubitably boys when they first donned the uniform - enlisted simply because they were swept up in the current of a nation tripping excitedly toward war. Many didn't even believe the government propaganda; they just longed for adventure.

One veteran recalls that they spent their spare time playing dice, talking about girls and getting drunk. Only at the war's end, as he and his comrades liberated a death camp, did they realize something else was at stake. "It all began to make a kind of sense to us," the veteran says, his chin quivering. "I'm not sure that made it any better. It may have made it worse, to see that it was actually conducted in defence of some noble idea."

Tom Brokaw called them "the greatest generation," and that description is seconded by Ken Burns and Lynn Novick in "The War." This 15-hour treasure recounts America's role in World War II on the battlefronts and the home front. It took longer to produce than the U.S. spent fighting the war, but the result is nearly as glorious.

It couldn't come at a better time. Although it offers no comparisons, there are obvious and stark contrasts viewers can draw between this war, which reached into every American life, and the wars in Iraq and Afghanistan that, despite advances in communication technology, feel remote and have scant impact on most Americans.

By showing the way American lives were shaped and changed by the conflict, "War" sets itself apart from previous documentaries on the subject. Even more ambitious than any previous Burns docu, including "The Civil War," this one paints a panoramic portrait not just of the fighting and the strategy in Europe and the Pacific but also of the impact on the country -- the entire American experience (to borrow the title of another PBS series).

When the United States sends soldiers to another country under any premise, and those soldiers are injured in performing their duty, they are owed care.

The government may not be able to give them back everything they lost -- the unscarred skin, the strong legs or arms, the clear eyes, the untroubled psyche. But it can provide treatment: Physicians' care, rehabilitation, prosthetics, counseling.

Instead, the care given to veterans returning from Iraq and Afghanistan has become a national scandal. Some wait months for care, or fester in dismal facilities. Others go home to be cared for by their families, who aren't prepared to shoulder the burden of round-the-clock nursing. ...

Congress can do better, by removing the barriers that too often deny soldiers the treatment they need -- like the cruelly adversarial process used to "prove" that a combat veteran legitimately suffered post-traumatic stress disorder.

Friday, September 21, 2007

Since last Friday, lucky moviegoers in LA, NY, Chicago, Boston, San Francisco, Seattle, and DC, have had the chance to catch the new Paul Haggis film starring Tommy Lee Jones, Charlize Theron, and Susan Sarandon. (Last weekend's returns were a whopping $14,839 per theater compared with $4,889 for Jodie Foster's "The Brave One.")

Opening nationwide today, "In the Valley of Elah" has been receiving great reviews. I'd like to share some of those with you, as well as a few film clips of this important film.

Maps will tell you it's a world away, but the Valley of Elah is closer to home than you might think. Perhaps, as Oscar-winning filmmaker Paul Haggis suggests in his latest film, "In the Valley of Elah" -- a movie that is every bit as important as it is powerful -- it is too close to home.

Well-stocked with Oscar-winning actors -- Tommy Lee Jones, Susan Sarandon, Charlize Theron -- "Elah" presents itself at first as a melancholy and low-key detective story, but as the story unfolds, it changes into something else entirely. By the final 30 minutes -- details of which the filmmakers have politely asked reviewers to keep under wraps -- it reveals itself as a sobering and thought-provoking tale about the persistent wounds that war inflicts on men and women in uniform.

Haggis' new film, which is set almost entirely stateside, is slow, somber and discreetly framed. It takes its cue from its central character, a retired Army sergeant who served in the military police and for whom ironclad control is first nature.

Tommy Lee Jones pours his underspoken authority into the painful role of Hank Deerfield, an unapologetic patriot who will interrupt an important errand to see that an incorrectly displayed American flag is flown properly. ...

In the Valley of Elah...uses a murder mystery to explore the psychic wounds brought back from a war zone by people who might have done things too horrible to face, much less share with a parent whose career was built on a firm concept of military honor.

Jones carries the film by blending Hank's confident strength with a father's heartsickness about what has happened to his son and how much of a role his expectations might have played in his son's tragedy.

That suggests a political argument, but Haggis' film avoids debate over the wisdom of our involvement in Iraq and the daunting mission our troops have been asked to tackle. This could be a drama played out in any war in which innocence and civility are inevitable casualties.

The writer-director who made audiences debate race issues with his Oscar-winning “Crash” turns to another hot-button topic with the powerful anti-war film “In the Valley of Elah.”

Showcasing death and dishonor among American troops — arguing that war dehumanizes our soldiers in Iraq, who in turn bring that altered reality home with them — it is another polarizing picture that will produce cussing and discussing.

Paul Haggis has created a complex tale that is equal parts detective story, father-son story and confirmation that the first casualty of war is innocence. ... But the star of “In the Valley of Elah” is the clever, provocative dialogue that Haggis uses to make a murder mystery something deeper.

While those words sting and sometimes prompt anger, they are important elements in films such as this — works of art intended to help heal the wounds of war.

Writer-director Haggis has created an issue-oriented intrigue of rock-solid confidence and rigor, especially after the cathartic grandstanding of his Oscar-winning race drama "Crash" (2004). Visually, the movie is a somber stunner, with a moody, gray-green palate perfectly suited to the story of a father driven to full, dark understanding.

Inevitably, that means a re-education for Hank, but one should not mistake him for some rough-and-tumble Cindy Sheehan stand-in. Rather, Hank represents the families of soldiers whose disillusionment has reached a quiet boil, and Jones portrays their plight with a strong but eminently humane face.

The deceptively simple story of a parent's grief over the death of a son and his need to discover what happened slowly builds into a penetrating inquiry about the casualties of war. Whereas Haggis' "Crash" smashed into controversial issues with a metal-to-metal crunch, his second feature whispers.

Haggis' script and restrained performances by the cast put the viewer on common ground with the subject matter. Tommy Lee Jones plays Hank Deerfield like an Everyman who quietly wears the aches of a lifetime in the bags beneath his eyes and the slow hitch of his walk.

“Elah’s” rage does not express itself in shouting or polemics; it’s hidden from view and ruthlessly contained at first. It surfaces only gradually until at the very end when the movie concludes not with a cry but with a devastating, despairing silence. It’s the silence of reverence for sacrifice, the silence of people struck dumb by grief over lives lost and lives warped.

The immediate dichotomy presented by "In the Valley of Elah" is regarding the value of human life. In war-torn Iraq, death is experienced on a daily basis. More than 3,700 U.S. troops have died in the four-plus years since the war started, and a recent report racks up Iraqi civilian casualties well past 1 million. Soldiers die there daily. It's almost expected.

When one is killed on U.S. soil, though, it's murder, warranting intense scrutiny. Untimely, violent death isn't supposed to happen here. But when it does, it opens an ideological can of worms. Soldiers suffer from near-debilitating post-traumatic stress disorder, which reflects poorly upon our government's foreign policy decisions. The armed forces are implicated, too, for perhaps not offering adequate mental-health treatment for the traumatized, and we have to wonder if they're more concerned about bad publicity than suffering individuals.

As the war in Iraq continues with no end in sight, I'm afraid we are in for more movies like "In the Valley of Elah." What I truly fear is that those other movies won't be as thoughtful or as moving as the drama director-writer Paul Haggis (his first movie since "Crash") has crafted about the personal costs of war. ...

Each of Haggis' Oscar-winning leads brings out facets of grief and resolve, with Jones particularly affecting as a man who realizes too late that his son may not have been prepared for combat - or that this kind of combat is more bewildering than anything he faced in his day.

Haggis doesn't preach overtly about the wisdom of the U.S. mission in Iraq or the competence of those in charge. He is examining the effects of any war on the human soul, on those in the fighting or their loved ones back home. If there is a message in "In the Valley of Elah," it's that it takes more to support our troops than sticking a ribbon-shaped magnet on the back of a car.

Canadian-born director Paul Haggis attempted to tap into what was happening with U.S. soldiers in Iraq with his new movie "In The Valley of Elah." Judging from the feedback he has received he may have succeeded.

After a recent screening of the movie in Washington, D.C., Haggis met three women within five minutes who each thanked him for making the movie. All three told Haggis that either their husbands or sons had killed themselves within a week after returning from a tour of duty in Iraq.

Haggis said the experiences of the women he spoke to show that these effects of the Iraq war on soldiers are not isolated incidents.

"So many suicides have been reported, and there are so many homeless returning soldiers, living in ramshackle conditions," he said. "This is a national problem, and we're just ignoring it."

Although the movie stars Tommy Lee Jones and Susan Sarandon as the parents of the murdered boy, and Jason Patric and Frances Fisher have key roles, several of the supporting parts are played by unknowns: veterans whose memories of Iraq were fresh.

"There's a level of truth there that's really hard to fake," said Haggis, who has shown the picture in rough-cut form to soldiers. "I didn't want to make a film that veterans would find false. It's not easy for them to watch, but they do say it's a true experience."

The startling, chilling conclusion is even more frightening when we recall that Haggis based his script on actual events, detailed in Death and Dishonor, an article by Mark Boal that appeared in Playboy magazine in 2004. It's the kind of lesson that was probably learned and forgotten by the veterans of Vietnam; it seems that every generation's war feels like the first, with the slate wiped clean and all the mistakes ready to be discovered and made anew.

There are already voices on the Fox television network decrying “In the Valley of Elah” as a slander on U.S. soldiers in Iraq, but it seems to me a far subtler and less polemic film than that and all the more moving for being so. I wish it were as coherent, plausible and cogent as it is subtle and moving, but don’t expect polemics or anything like the horrific, vile kind of soldierbaiting that afflicted bad movies and TV in the Vietnam era (not “Coming Home” or “Platoon” but all that Hollywood garbage that routinely turned Vietnam vets into murdering psychos).

Haggis, who long ago became a U.S. citizen, makes no show of impartiality. "You know how conservatives always say, 'Hate the sin, love the sinner?' Well, I admire the people who serve their country for all the right reasons, but not the people who send them to die and be shot at for all the wrong ones. If some people get angry about the movie, good. I want Americans to see this and think about what we're doing. Then do something to stop it."

While a wide variety of events can trigger what's called post-traumatic stress disorder, this PTSD blog focuses solely on the combat-related variety.
As a new generation of warriors returns to civilian life and seeks out resources, PTSD Combat is here to help.

Considerable Quotes

"The first shamans earned their keep in primitave societies by providing explanations and rituals that enabled man to deal with his environment and his personal anguish. Early man, no less than we, dealt with forces that he could not understand or control, and he attempted to come to grips with his vulnerablity by trying to bring order to his universe." -- Richard Gabriel in No More Heroes

"War stories end when the battle is over or when the soldier comes home. In real life, there are no moments amid smoldering hilltops for tranquil introspection. When the war is over, you pick up your gear, walk down the hill and back into the world." -- OIF vet John Crawford in The Last True Story I'll Ever Tell

"After wars' end, soldiers once again become civilians and return to their families to try to pick up where they left off. It is this process of readjustment that has more often than not been ignored by society. -- Major Robert H. Stretch, Ph.D in Textbook of Military Medicine: Vol. 6 Combat Stress

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